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SNIS 20th annual meeting oral abstracts
O-021 Concurrent middle meningeal artery embolization for treatment of chronic subdural hematomas
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  1. W Salah1,
  2. C Baker2,
  3. J Scoville2,
  4. J Hunsaker3,
  5. C Ogilvy4,
  6. J Moore4,
  7. H Riina5,
  8. E Levy6,
  9. A Spiotta7,
  10. B Jankowitz8,
  11. C Cawley9,
  12. A Khalessi10,
  13. O Tanweer11,
  14. R Hanel12,
  15. B Gross13,
  16. O Kuybu14,
  17. A Nguyen Hoang15,
  18. A Baig6,
  19. M Khorasanizadeh16,
  20. A Mendez13,
  21. G Cortez17,
  22. J Davies6,
  23. S Narayanan13,
  24. B Howard9,
  25. M Lang13,
  26. A Siddiqui18,
  27. A Thomas4,
  28. P Kan19,
  29. J Burkhardt8,
  30. M Salem8,
  31. R Grandhi1
  1. 1Neurosurgery, University of Utah School of Medicine, Salt Lake City, UT, USA
  2. 2Neurosurgery, University of Utah Department of Neurosurgery, Salt Lake City, UT, USA
  3. 3University of Utah School of Medicine, Salt Lake City, UT, USA
  4. 4Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
  5. 5Neurosurgery, NYU Langone Medical Center, New York, NY, USA
  6. 6Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, Williamsville, NY, USA
  7. 7Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
  8. 8Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
  9. 9Neurosurgery, Emory University, Atlanta, GA, USA
  10. 10Neurosurgery, University of California San Diego, La Jolla, CA, USA
  11. 11Neurosurgery, Baylor College of Medicine, Houston, TX, USA
  12. 12Neurosurgery, Baptist Neurological Institute, Jacksonville, FL, USA
  13. 13Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
  14. 14Neurology, University of Pittsburgh, Pittsburgh, PA, USA
  15. 15Neurosurgery, Houston Methodist Neurological Institute, Houston, TX, USA
  16. 16Neurosurgery, Mount Sinai Health System, New York City, NY, USA
  17. 17Stroke and Cerebrovascular Surgery, Baptist Neurological Institute, Jacksonville, FL, USA
  18. 18Neurosurgery, University of Utah School of Medicine, Williamsville, NY, USA
  19. 19Neurosurgery, University of Texas Medical Branch, Galveston, TX, USA

Abstract

Non-acute subdural hematomas (NASHs) are expected to be the most common cranial neurosurgery pathology encountered by the year 2030. Treatment with surgical evacuation may be necessary, but the rate of recurrence after surgical intervention has been reported to be as high as 30%. Minimally invasive middle meningeal artery embolization (MMAe) during the perioperative period has been posited as an adjunctive treatment to decrease recurrence after surgical evacuation of NASH. The authors evaluated the safety and efficacy of MMAe in a multi-institutional cohort.

Data from 145 patients with NASH who underwent surgical evacuation and concurrent MMA embolization in the perioperative period were retrospectively collected from 15 institutions. The primary outcome was rates of NASH recurrence requiring repeat surgical intervention. We collected clinical data including use of anticoagulants and/or antiplatelets, prior treatment of NASH, and perioperative platelet counts; treatment data including anesthesia type, type of embolic agent, length of hospital stay, and access type; and radiographic data including laterality of the NASH, presence of subdural membranes, MMA size, presence of dangerous collaterals, and median width of the NASH at initial presentation, after evacuation, and at 90-day follow-up. This data can be seen in table 1. Radiographic features of the NASHs at last follow-up were included size reductions/improvements. Radiographic features at last follow-up are summarized in table 2. Outcomes data collected included: mortality, adverse events, and modified Rankin Scale (mRS) score at last follow-up, results can be seen in table 3.

The median preoperative hematoma width was 18 mm, and subdural membranes were present on imaging in 87% of patients. At 90-day follow-up, the median NASH width was 6 mm, and 51% of patients had at least a 50% decrease of NASH size. At last clinical follow up, 87% had the same or improved mRS score. Eight percent of treated NASHs had recurrence requiring additional surgery. The total all-cause mortality was 6%.

This study provides evidence from a multi-institutional cohort that performing concurrent MMAe in the perioperative period as an adjunct to surgical evacuation is a safe and effective means to reduce surgical recurrence in patients with NASHs.

View this table:
Abstract O-021 Table 1

Procedural details of 145 patients (149 NASHs) who underwent concurrent MMAe

View this table:
Abstract O-021 Table 2

Radiographic characteristics of 149 NASH that underwent treatment with concurrent MMAe

View this table:
Abstract O-021 Table 3

Outcomes of 149 NASHs that underwent concurrent MMA embolization

Disclosures W. Salah: None. C. Baker: None. J. Scoville: None. J. Hunsaker: None. C. Ogilvy: None. J. Moore: None. H. Riina: None. E. Levy: None. A. Spiotta: None. B. Jankowitz: None. C. Cawley: None. A. Khalessi: None. O. Tanweer: None. R. Hanel: None. B. Gross: None. O. Kuybu: None. A. Nguyen Hoang: None. A. Baig: None. M. Khorasanizadeh: None. A. Mendez: None. G. Cortez: None. J. Davies: None. S. Narayanan: None. B. Howard: None. M. Lang: None. A. Siddiqui: None. A. Thomas: None. P. Kan: None. J. Burkhardt: None. M. Salem: None. R. Grandhi: None.

https://doi.org/10.1136/jnis-2023-SNIS.21

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